Welcome to the Use Case Podcast, episode 211. Today we have David from Amino about the use case or business case for why his customers use Amino.

Amino’s Smart Match provider recommendations help you quickly see which doctors and facilities are in-network.


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Thanks, William

Show length: 27 minutes

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David Vivero
Co-founder and CEO Amino

David Vivero is co-founder and CEO at Amino, guiding the vision and direction of the company and its personalized, consumer-centric, and data-driven approach to health care. Previously, David was VP of Rentals at Zillow, responsible for the world's largest online rental marketplace.


Music: Welcome to RecruitingDaily’s Use Case podcast, a show dedicated to the storytelling that happens or should happen when practitioners purchase technology. Each episode is designed to inspire new ways and ideas to make your business better. As we speak with the brightest minds in recruitment and HR tech, that’s what we do. Here’s your host, William Tincup.

William Tincup: Ladies and gentlemen, this is William Tincup and you are listening to the Use Case Podcast. Today, we have David on from Amino and we’ll be learning about the business case or the use case that his prospects use to purchase Amino. And for his customers that probably continue to use Amino. So without any further ado, let’s just jump right into it. David, would you do me a favor and introduce yourself and Amino?

David Vivero: Absolutely. And thank you so much for inviting me on. Really excited to share our story. I started Amino, nine years ago, a group of us were entrepreneurs that were at the time inside of Zillow, the transparent real estate marketplace and left to start a new company. And it was actually on my last day of Zillow that I discovered Amino, because I got my one pager on Cobra that said, Hey, you’re on your own. And here’s where you mail your premium. There’s the PO box in Alpharetta, Georgia. And you wish you well. And you know, that didn’t seem right to me. And the fees didn’t seem commensurate with the way I used healthcare at the time, but I had a preexisting condition and this was 2013. And so I went off and looked for healthcare in the individual market. Couldn’t get healthcare because I didn’t want to pay the cobra premium. Couldn’t get in the individual market. My entrepreneurial mind started to start… the wheels started turning.

William Tincup: There’s got to be a better way. There’s just got to be a better way.

David Vivero: And here we are. Eight, nine years later and it’s been such an amazing journey because to some extent we were right, but we were a little early. The US healthcare market is absolutely opaque and inaccessible, high stakes, frustrating, oftentimes a major cause of bankruptcy and at the very least severe, severe distraction and anxiety for people. And we evolved over the course of the years, where first we started developing this principally for consumers. So we went to amino.com, we published data on where the safe hospitals are and where the expensive doctors offices are and who’s giving care that they shouldn’t. And who’s a real expert in deep brain stimulation for Parkinson’s disease. You name it. So we supported this Zillow like marketplace online and that was incredibly successful among consumers. And when we started to build a business model, we realized that we needed to really contour it to health plan sponsors.

And that’s when we started to work with employers and folks who think about total rewards and talent and how to support these large communities of people who themselves are spending the company dollar on healthcare and not getting what they deserve. And so we started Amino as an employer benefit a couple years ago and it’s just been tremendous success. And I can tell you a little bit more about that, but the goal of really partnering with health plan sponsors to make sure that we deliver that access, that convenience to member as well, also making sure that people are protected and that they’re protected financially and physically from getting care they don’t need, care that’s unsafe or care that’s overly expensive. It’s a great way to wake up in the morning.

William Tincup: Let’s jump into that right there because I don’t think people understand the getting too much care or getting the wrong care, getting possibly things that are dangerous for you. So unpack that a little bit for the audience.

David Vivero: Well, you’ve got, 150 to 200 million Americans that get their healthcare through employers and employers are facing a challenging healthcare environment in the US. Their costs have continued to rise. They’re innovating on all sorts of health plan designs. That’s why you’ve seen healthcare deductibles grow so much over the course of the last 10, 15 years. Hasn’t necessarily stopped the bullet train of increased costs. So you’ve got these narrower networks, you’ve got folks trying everything. They’re putting clinics downstairs. They’re giving people telemedicine. And so healthcare utilization, I think is really inefficient. So the cost and complexity keeps growing because we keep throwing more things to try and stop the growth of it. And when you’re a consumer, you’re like, gosh, I used to just show up with my health insurance card. And I walked into doctor’s office and they gave me care and I paid 20 bucks or whatever it was. And, and I was really thankful for my employer.

Now, I have to be a PhD to understand, well, your plan design and you’ve got this tiered network and here’s your level one doctors, but you’ve also got a clinic downstairs. And you know, since you have diabetes, you should use a diabetes specific program. And so what Amino health is we are defining the digital first guidance market. We’re actually using all of this data about what 200 million people do when they go get care. We basically are watching this live feed from the US healthcare system, that’s anonymous, but it allows us to see what people like me have done. It allows me to understand where to guide people within the brick and mortar providers of care like this hospital, that surgical center, that urgent care center. That’s the one where you’re not going to get screwed. That’s the one where you’re going to get good care.

And then also we are able to very contextually say, Hey, bill, you just looked up back pain and your employer has spent months researching back pain interventions. And they partnered with a company that focuses on musculoskeletal problems and you have never need to worry about back pain in your life. And this is the first time you’ve ever had to worry about it in your life. Here, let’s introduce you to that benefit. You’re going to get treated in your home and your employer, that HR team that spent forever trying to vet a solution like that got one more person engaged with it. And their investment has been validated. So everybody wins, because we are guiding people to choose the right provider of care, the right benefit. That’s going to help solve their need and keep them out of bankruptcy, keep them out of the hospital.

William Tincup: So a natural question, I’m sure you get asked all the time. Does it go all the way down to the doctor level? Cause you can go down to obviously down to the facility and probably even the specialization within the facility. Do you either now, or do you see kind of the future where you go all the way into this doctor versus that doctor?

David Vivero: Well, don’t we? Don’t we get care from doctors. So that’s the key thing, right? It’s the thing about healthcare that has just really frustrated me since becoming a healthcare Maven, I’m kind of a… It’s an acquired skill. Is that so much doesn’t start from just what you and I need as people.

William Tincup: Right.

David Vivero: And the reality is, we were picking a surgeon. So what Amino does it talks about… Well, this person does surgery a lot, probably more than they should. You’re going to walk in there and they’re more likely than they should going to recommend surgery. Well that could put you on a path toward opioid abuse.

William Tincup: That’s right.

David Vivero: That could put you on a path toward repeat surgeries. So we’re at the individual surgeon provider, primary care doctor level, we’re talking about appropriateness and judiciousness of care. We’re talking about when they bill your health insurance company, meaning your company, Aetna, Cigna, United, whomever, what are they going to charge? What are you going to be responsible to pay? And you’re not just going to be responsible for that one little billing code. You’re going to get a bill.

William Tincup: That’s right.

David Vivero: Hell, you’re going to get a few bills because you’re going to get a bill from the anesthesiologist.

William Tincup: That’s right.

David Vivero: And you’re going to get a bill from the facility. So one of the things that makes Amino, orientation unique is that we are focused on simplifying healthcare’s complexity for the consumer, which means like how do we make all of this stuff way more accessible and convenient. And so we do that extra work of saying like, Hey, we’re going to go down to the physician level. And we are going to think about how do this physician relates to what facility you’re likely to get your endoscopy in or colonoscopy and so forth. So you don’t have to think about it.

William Tincup: I love that. Have you been asked or you see it on the roadmap around pharmacies in interactions like of medicine? I’m thinking about questions I’ve been asked as it relates to this doctor doesn’t know about this doctor does know about this doctor and they’re all prescribing different things. Is there a way to then understand for each doctor? I mean, they’d all like to actually understand what you’re taking supplements and vitamins and prescriptions wise, do you see kind of a meta way of bringing that data together so that the providers understand and they have insight into what their patients are taking?

David Vivero: It’s a great question. And we think about prescriptions in a few ways. One is that there are tools out there for you to get the price of a prescription drug at a given facility. So GoodRx is out there, got a ton of respect for what they do. There are other vendors that do that specifically for employers. What we really focus in on is you’re going to save a little bit of money go in into this Walgreens instead of that CVS or what have you. But by far and away, the way to save money on prescription drugs is to go to folks who prescribe smartly. You’re still back at the physician, right? You are getting somebody who’s aware that there’s a generic drug, that’s just as good as the branded and isn’t going to set you back a bunch of money.

Are they prescribing opioids judiciously and not putting someone on a path of addiction? Are they thinking about the treatment of heart disease in a way that makes sure frankly, that they are prescribing the necessary statins and other things like that in the right amounts for someone that goes to see them. So a lot of this is about making sure that people are getting not just less care, it’s about getting the right care. Are they prescribing the right types of drugs? Are they aware of cheaper alternatives? And are they actually prescribing in ways that are going to keep you healthy and not either on a path to addiction or to potentially having additional complications?

William Tincup: Right.

David Vivero: So that’s how we think about prescription drug. And then you can go to individual pharmacies and there’s, there are some differences, but not as substantial as like the difference between someone who’s going to prescribe the right drug or not.

William Tincup: Right. And what about the folks that’s using Amino on a day to day basis? I would assume these are the benefits admins folks, or who do you see as kind of in their and using it from the company’s perspective on a daily basis?

David Vivero: All of us, ordinary people. The thing that’s amazing about Amino is we’ll sell a sponsorship. If you will, a subscription to an employer, who’s got, let’s say they’ve got 10,000 people that work for them. Plus 10,000 people where they’re spending $10,000 a year on healthcare. I mean, these are significant dollars that they’re spending on care, of those 10,000 people, almost half of them are going to register on their own, create an account and do a search on Amino. If you think about how mindbogglingly high that engagement rate is, just think about the fact that if you have 10,000 people between the ages of 18 to 64, only two thirds of them are going to seek healthcare at all in that given year. So the CDC says that about two thirds of working age people are actually going and getting care for a new doctor every year.

We’re getting half of the eligible people that are actually using Amino. And what’s really cool about it is we know because we have all this data that powers our system. You can imagine what’s at the core of Amino is this massive stream of data that tells us every day, where are people getting care? They may or may not be our users. And in fact, they’re likely not to be our users because we don’t have a majority of 200 million people, we’ve got single digit millions on the Amino platform. Well, we know what those people do. That’s kind of our control group. We say, all right, those folks don’t have access to Amino. Well, how many of them use our recommended doctors? Use our recommended facilities? And we’re able to say, on average, what is that 5-10% of a given network.

So I’ll just give you an example, let’s say you had a need for an ACL surgery in Chicago and the Chicago land area. We are able to know, Hey, 5-10% of people are going to pick our, what we call smart match physicians. These are the folks that have really met our quality standards, our appropriateness standards, our experienced standards. They’ve met our cost thresholds. These are the high value providers and we just look at our own data. Wow. Like a majority of all the online appointments that get booked on amino are with those top flight providers.

William Tincup: Oh wow.

David Vivero: And so what’s really cool about us is that it’s ordinary people who register and use it and engage it. This thing has a net promoter score over 80. So people really come back. They’re actually searching on our product multiple times a year, coming back to us and logging in multiple times a year.

And the most important thing is that we are proven to change their behavior. We are proven to get them to drive one further exit down the highway and go to a different doctor’s office because they are safer, cheaper, more experienced, more appropriate, just better all around. And that is where the health plan sponsor, the employer that had a total rewards is really feeling the benefit is that, this isn’t just an app or a site where people are just loading it up. They’re actually taking action on it. And they’re taking actions that are different than they would take if they were doing it alone.

William Tincup: Do you currently, or do you see kind of in the future a way of looking at EAPs in much the same way? Like some of the stuff like, there’s obviously you’re hearing all the same things I’m hearing about mental health, especially because of the… How do we evaluate that? How do we evaluate what you should, where you should go and how to consume and how not to get the wrong service, as I think you appropriately said at the very beginning. So it’s about getting the right service. And so have your clients already asked you about EAPs or do you think that there’s a future for Amino to look at EAPs in the way that y’all look at facilities and doctors?

David Vivero: You are… Appreciate the choir here. So you know, obviously you’ve interacts a lot with your listeners. I’m sure. Cause this is common, right? That mental health access issues in the US are just absolutely dreadful.

William Tincup: Right.

David Vivero: And so, that speaks to our strengths. We are an access oriented company. We make healthcare a lot more convenient because inside of your phone, tap, tap with your thumb, you’ve got an appointment with a primary care doc or with a imaging center or in urgent care center down the street. Well, mental health is one of those folks that suffers one of those areas that suffers most from access issues. Well, in January we released Amino’s mental health program and that allows you, if you are depressed, dealing with bipolar, dealing with anxiety, dealing with the number of presentations that would get you to raise your hand and seek mental health support, you can use Amino to do that alongside all of your physical wellbeing.

So all of the surgeries and other chronic needs you might need inside of your medical plan, we are able to interact with the EAPs two ways. One is inbound and the other is outbound. And so by inbound, let’s say you’re using Amino. You have no idea what your EAP is, that three letters to most employees or their family members. And so you could type into something like Amino, like depression or chronic pain or sleeping issues that allows us to… We’ll surface the local primary care docs or you know, mental healthcare providers, whatever’s appropriate to what you search for. But we’ll also say, you’ve got an EAP and here’s the phone number and we’ll actually guide people. They’ll talk about what they know is their problem.

You could think of it as like stitching together seamlessly the benefits packages, the providers that are out there in the world, that can treat me, all those things could stitch together. So outbound or I should say inbound to the EAP, we can actually increase the use of EAPs. And we are doing that. We’re actually tripling the engagement rates of typical, what we call integrated benefits. It’s not just an EAP. It could be a diabetes program.

William Tincup: Right.

David Vivero: Or it could be a cancer care, second opinion service. I mean, these are things where it’s like, man, if you could just drive one incremental use of these, it could be game changing for the member and for the plan. And then when I mentioned… That’s inbound. Outbound, let’s say you call into that EAP or into that telemedicine service. Sometimes they can’t treat you right there over the phone.

Sometimes they need to make a recommendation and that person who’s wearing a headset, who’s talking to you, needs a tool that helps him say, all right, Bill’s calling me, he’s on this plan. He’s on this network. I’m currently in Oklahoma city and bill is calling from Orange county, California. Amino has an app that supports those call centers and being able to support members as well, we call it Amino refer. And that allows those folks to be able to refer smartly as if the member were serving themselves, just pull up the member’s profile, book an appointment for them, that person can get off the phone and literally have an appointment waiting for them at a local mental healthcare provider that the EAP set them up with.

William Tincup: I love this on so many levels. One of the things I would like to ask… it’s a magic wand question. So if you could change benefits for companies to kind of right size, kind of what you see kind of then metadata and what people are consuming and what they need, quite frankly, what advice would you be in? And what I’m really thinking about is the companies that listen to the show that are starting out. So they’re in high growth, they’ve done a seed round, they’ve raised some money and, they’re about to go and hire 300 employees. So it isn’t off the rails yet, but it’s going to get off the rails at one point.

David Vivero: Yeah.

William Tincup: What would you lay down as your advice? And what do you give advice when you’re with your current customers, how do you give advice on just right sizing the package for their employees?

David Vivero: Well, you’re saying advice to other entrepreneurs. And so…

William Tincup: Yeah.

David Vivero: I’d say number one, it’s all about people. It is all about people, right? These are hard things to do. Build any business is hard. Every single startup company you ever read about is a 10 year long, overnight success story. And the businesses that all looked like they were rocket ships. You can feel those G’s and you can feel the rattling of that platform inside. And for most folks who were on their way to the moon, they felt like they were about to crash down on the way there multiple times. And you can hear all the horror stories from folks inside of some of America’s most vulnerable brands to hear that, it’s never smooth when you’re moving this fast. And so the number one thing is making sure that you work with a absolutely amazing high integrity, high creativity, high empathy, high collaboration people who want to see this through, who want to build something absolutely remarkable.

And that to me has been the difference maker. I’ve had the privilege of just getting to work with some of the most outstanding individuals, principally because we were both, or all of us we magnetically pulled into this mission. And in the early days, that means being flexible and being a generalist and being a franchise kind of player who just wants to, or I should say you what’s the right word utility player. That just wants to make sure that we build something great. And then having the ability to know when some of our old processes aren’t serving us, because we’re three times the size. We more than doubled our team last year. We’ve more than doubled our revenue every year for the last three, four years. So, what I like to say is that if you’re twice as good or three times, as let’s say you’re tripling, if you’re three times as good as you are next year and we’ve tripled the complexity and size of the business, then you’re just keeping up.

So a lot of this is how are we able to really collaborate as a team to level ourselves up. But it’s all about people. And then as far as right sizing benefits, the plan sponsors out there, the benefits leaders, I’d say the thing that we’ve really absorbed is that what we are, what we did, which I don’t think anyone else has ever done is we built a direct to consumer business first for four years. So we battle tested something that is naturally high engagement and that members are proven to use and make decisions on the vast majority of employee benefits do not have highly measurable ROI. There’s a lot of inference. There’s a lot of correlation.

William Tincup: Right.

David Vivero: But you’re not in with the… You’re running the equivalent of running a shopping cart system for healthcare. People are literally shopping for their care, they’re booking their appointments, they’re calling the phone numbers and all that’s trackable. And we want every one of our health plan sponsors to feel like they’re Jeff Bezos and they’ve just launched the Amazon for their health plan. And they can see every single purchase like gets made, not who made it. We respect the…

William Tincup: Of course.

David Vivero: … privacy of everyone. But the ability to be like, I know exactly what this program is doing for my healthcare. That’s the level, that’s the standard we have. We think that’s the standard that everyone else should have. And by making this program accessible to everyone, I’ll give you an example. We launched this in Spanish, in January.

William Tincup: Oh cool.

David Vivero: We’re able to take that base level of convenience and make it a tool for health equity, make it a platform for driving real convenient and less bewildering access to the American healthcare system for folks who are generally shut out. And for people who don’t get the type of care that they deserve. And so this front end does more than just provide convenience and value. It is also changing the way that people experience healthcare. And that’s what gets us up every day. But the way that we pay for it though, is that we are able to show that everything we do generates value for this plan sponsor, who’s really trying to make sure that they can get their benefits to go as far as they can.

William Tincup: That’s right. Last question. And because you’re sitting on all this metadata, have you ever been looking at the feed and you see something that just, I don’t know, perplexes you, like throws you off. Like you were thinking left and it went right. Or something like that. Is there anything, and again, no names or anything like that. Because you’re sitting on this amazing data, I’m just really curious about sitting on this feed and then staring at it and then going, huh? Why is that? I don’t understand. Why is that happening? Is that happening pretty much every day or every moment or is…

David Vivero: Yeah, pretty much. I think the reality is, it’s so funny. We have this intuition, right? That like, Hey, doctors are just humans.

William Tincup: Yeah.

David Vivero: And facilities are facilities that are run by, guess what, humans. And health systems that are big complex health systems affiliated to some of the nations, most vulnerable universities are run by, that’s right, humans. And all of us, not all of us were the valedictorian and all of are not great at everything. We have strengths, we have weaknesses. And so if we have strengths and weaknesses and the US healthcare system is administered by us, then the US healthcare system has strengths and weaknesses.

William Tincup: Right.

David Vivero: And what Amino is able to do is its able to match every individual care need to the place and people that have the greatest strengths in supporting that person. Because if you just follow the billboard inside a Dallas Love Field, and you think you’re going to get the best healthcare ever by going to UT Southwestern, or if you know, are only listening to the US news and world report rankings, there’s just not one score card you can apply to these things. And so what’s amazed to me is that you get really high value care at some of the most expensive health systems in the country, because they’re just that much better. They’re that much more experienced. They’re that much more safe and so forth. You also can…

William Tincup: [inaudible 00:25:46]

David Vivero: Get great cancer care and great surgical care at community doctors.

William Tincup: Yep.

David Vivero: Because you don’t need the forefront of research for some cases. And so the most important thing is that this variation in American healthcare is so complex that there’s no way one of us could decipher it. And so our algorithm is what we’ve done. I think allow us to recognize that the US healthcare system is full of strengths and weaknesses. We are able to map people to these strengths and any single scorecard is just not going to cut it. And so that’s been our biggest learning

William Tincup: Drops Mic. Walks off stage. David, and I love that the Love Field reference by the way, cause I’m in Arlington.

David Vivero: Okay.

William Tincup: So thank you so much for that. But seriously wonderful. I love what you’re doing and just you’re doing just great work and I’m just really, really happy. And thanks for coming on a podcast.

David Vivero: Thank you. Thanks for your interest.

William Tincup: Absolutely. And thanks for everyone listening to the Use Case Podcast until next time.

The Use Case Podcast

William Tincup

William is the President & Editor-at-Large of RecruitingDaily. At the intersection of HR and technology, he’s a writer, speaker, advisor, consultant, investor, storyteller & teacher. He's been writing about HR and Recruiting related issues for longer than he cares to disclose. William serves on the Board of Advisors / Board of Directors for 20+ HR technology startups. William is a graduate of the University of Alabama at Birmingham with a BA in Art History. He also earned an MA in American Indian Studies from the University of Arizona and an MBA from Case Western Reserve University.


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